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# Regional Strategic Chemotherapy Group

Guidelines for the use of the Cockcroft & Gault Formula to calculate
Creatinine Clearance in Adult Cancer Patients
The Cockcroft and Gault (C & G) formula is used to assess a patients renal function, in the absence of an
EDTA, as per guidelines in individual chemotherapy protocols.
Please note that eGFR should not be used to adjust doses for any medicines, including chemotherapy.
C & G Formula for MALE:
Creatinine Clearance = 1.23 x (140 - age in years) x TBW* (in kg) or Adjusted Body Weight (see below)
Serum Creatinine (mol/L)
C & G Formula for FEMALE:
Creatinine Clearance = 1.04 x (140 - age in years) x TBW* (in kg) or Adjusted Body Weight (see below)
Serum Creatinine (mol/L)
*TBW = Total body weight
The C & G formula needs to be interpreted with caution in patients who are:
Obese
o If the patients Total Body Weight (TBW) is more than 130% of their Lean Body Weight
(LBW), as calculated below, using the patients TBW in the C&G calculation will
overestimate renal function.
o Instead, use the Adjusted body weight, which falls between lean body weight and total
body weight as follows:
Adjusted body weight = LBW + 0.4 (TBW LBW)
To calculate Lean Body Weight (LBW) for MALE:
LBW (kg) = 50 + (0.906 x (height in cm 152.4))
To calculate Lean Body Weight (LBW) for FEMALE:
LBW (kg) = 45 + (0.906 x (height in cm 152.4))

## Oedematous or have ascites

o Estimate dry body weight (i.e. total body weight minus weight due to accumulated fluid)
and use this in the C & G calculation
o Substitute dry weight for total body weight if calculating Adjusted Body Weight

Emaciated
o Use TBW in the C & G calculation

## In Acute Renal Failure

o If 2 serum creatinine levels in 24 hours vary by more than 20mol/L, the serum creatinine
will no longer reflect the true clearance rate and the measure of renal function will be
inaccurate.

## Reason for Update: convert to Network document; add CrCl

cap for calculating carboplatin doses using C&G
Version: 4
Prepared by: S Taylor

## Approved by Chemotherapy Group Chair: Dr J De Vos

Date: 18.4.13
Checked by: C Tucker

## Using C&G for Carboplatin Dosing:

There is no UK national guidance, but as of October 2010, the U.S. FDA recommends
that, when renal function is estimated based on serum creatinine, a cap of 125 ml/min
should be used for carboplatin calculations. Be very careful if you choose a higher cap.
Capping the CrCl is not necessary when the patients renal function is measured using
EDTA or 24 hour urine collection.
References:

Churchills Clinical Pharmacy Survival Guide. Barber & Wilson, Churchill Livingstone
1999
Basic Clinical Pharmacokinetics Michael Winter 3rd Edition, Applied Therapeutics Inc.
Vancouver, 1994.
Devine, BJ. Drug Intell Clin Pharm 1974 (7): 650 655
Devaney, A et al; Pharm J 2006; 277: 403 404

## Reason for Update: convert to Network document; add CrCl

cap for calculating carboplatin doses using C&G
Version: 4
Prepared by: S Taylor

## Approved by Chemotherapy Group Chair: Dr J De Vos

Date: 18.4.13
Checked by: C Tucker